Abstract
Purpose When swallowing efficiency is impaired, residue accumulates in the pharynx. Cued or spontaneous swallows in the head neutral position do not always successfully clear residue. We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture. Methods Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy. Participants were cued to perform a head-turn-plus-chin-down swallow, with the direction of head turn randomized. Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software. Measures of % full and the Normalized Residue Ratio Scale (NRRS) were extracted. Univariate analyses of variance were used to detect significant reductions in residue. Results On average, pre-maneuver measures showed residue filling 56-73% of the valleculae, depending on stimulus consistency (NRRS scores: 0.2-0.4). More than 80% of pre-swallow measures displayed NRRS ratios > 0.06, a threshold previously linked to increased risk of post-swallow aspiration. Conclusion The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids, suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies.
Highlights
Videofluoroscopy is the current gold-standard method for evaluating swallowing pathophysiology in people with dysphagia, using a standardized protocol
Due to the radiographic exposure associated with this tool, videofluoroscopic evaluations must be restricted in duration, typically involving between 3 and 11 boluses per assessment[1,2,3]. It is within this very narrow window that treatment decisions have to be made. One of those decisions involves the choice of compensatory techniques that are appropriate to address the specific pathophysiology demonstrated by the patient
In this study we investigated the utility of a novel maneuver, combining a head-turn with the chin-down posture, for reducing post swallow vallecular residue using a cued clearance swallow
Summary
Videofluoroscopy is the current gold-standard method for evaluating swallowing pathophysiology in people with dysphagia, using a standardized protocol. Due to the radiographic exposure associated with this tool, videofluoroscopic evaluations must be restricted in duration, typically involving between 3 and 11 boluses per assessment[1,2,3]. It is within this very narrow window that treatment decisions have to be made. The presence of residue has been shown to have prognostic value in predicting the outcome of rehabilitation for stroke patients with dysphagia. Park et al[15] reported that stroke patients with greater residue in the valleculae and pyriform sinuses had poorer treatment outcomes following a rehabilitation protocol involving neuromuscular electrical stimulation
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